Dynamic 18 F-PSMA-1007 PET-CT kinetics as a prognostic marker in newly diagnosed prostate cancer: a prospective pilot study

BACKGROUND: Prostate cancer remains a leading cause of cancer-related morbidity and mortality among men worldwide. Recent advances in molecular imaging, particularly Prostate-Specific Membrane Antigen labelled (PSMA) PET-CT, offers more robust diagnostic accuracy over conventional imaging with information regarding actual disease burden. OBJECTIVE: This study evaluates the diagnostic and prognostic significance of dynamic PSMA PET-CT parameters, focusing on time-activity curve (TAC) patterns in newly diagnosed prostate cancer patients. METHODS: A prospective single-arm study was conducted at a tertiary care center in India, involving 29 patients with histologically confirmed, untreated prostate adenocarcinoma. They underwent dynamic pelvic PSMA-1007 PET-CT followed by delayed whole-body 18 F-PSMA-1007 PET-CT scans. The time-activity curves (TACs) were generated from dynamic imaging and categorized into early and late crossing based on a 15-minute threshold limit. Patients were stratified by CHAARTED criteria (disease volume), Gleason score, and Serum PSA levels. Statistical analysis included t-tests, chi-square tests, regression analysis, and correlation studies. RESULTS: Early TAC crossing was found in 69% of patients and was significantly associated with high disease volume (100%, p = 0.001) and higher serum PSA (p = 0.003). Late crossing patterns correlated with lower disease burden and 100% survival. Gleason score did not show any significant correlation with the disease volume or survival outcomes. TAC pattern was an independent predictor of disease volume (p < 0.0001). CONCLUSION: Dynamic PSMA PET-CT imaging can prove to be a significant tool for diagnosis and prognostication of newly diagnosed case of prostate cancer. Early crossing TAC patterns indicate more aggressive disease and overall poor prognosis.